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Published byPaul Ford Modified over 9 years ago
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Minimally Invasive Spine Surgery and Posterolateral Endoscopic Discectomy Gabriele Jasper, M.D. Anesthesiologist Interventional Pain Physician Center for Pain Control Brick, NJ Milltown, NJ
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Common Indications- Posterolateral Endoscopic Discectomy 1.A patient with back pain and/or radicular pain who has failed conservative treatment 2. Any herniation accessible endoscopically (directly proportional to experience) 3. Patient who refuses open surgery 4. Discogenic Pain 5. Discitis
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Contraindications - Endoscopic Spine Any pathology not accessible from the posterolateral endoscopic approach –Severe central canal stenosis Inadequate support staff or equipment to successfully perform procedure Uncooperative patient Instability
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Surgical Approach Kambin’s Triangle Exiting Nerve Endplate Transversing Nerve Root
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MRI with HNP and Facet Hypertrophy Neuroforaminal Stenosis T2 sagittal MRI showing HNP, left L4-L5 with compression of L5 nerve root T2 axial MRI showing HNP left L4-L5 with compression of L5 nerve root
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The Inside Out Technique The Outside Inside Technique
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Disc Approaches
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The Endoscopic Approach Surgical approach The interventional pain approach The modified surgical/interventional pain approach
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Surgical Approach
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Interventional Pain Approach
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Endoscopic HydroDiscectomy Instrumentation SpineJet ® EndoResector
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Endoscopic Discectomy with Foraminotomy and Annuloplasty
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Defect Created By the EndoResector
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Pre-op Orders 1.Standard Pre-op Orders 2.Ancef 1gm I.V. or Gentamycin 3. All solutions that enter the disc need to have 10% antibiotic
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Post-operative Orders 1.Follow-up one week 2. Back Brace during activity for six weeks 3.No work 1-2 weeks (depends on type of work) 4.No heavy lifting until re-evalution 5.Pain Medication
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Questions ??
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Thank You
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